Welcome to the Mad in America podcast, a new weekly discussion that searches for the truth about psychiatric prescription drugs and mental health care worldwide.

This podcast is part of Mad in America’s mission to serve as a catalyst for rethinking psychiatric care. We believe that the current drug-based paradigm of care has failed our society and that scientific research, as well as the lived experience of those who have been diagnosed with a psychiatric disorder, calls for profound change.

On the podcast over the coming weeks, we will have interviews with experts and those with lived experience of the psychiatric system.

Thank you for joining us as we discuss the many issues around rethinking psychiatric care around the world.

Dr Kirsch is Associate Director
of the Program in Placebo Studies and lecturer in medicine at the
Harvard Medical School and Beth Israel Deaconess Medical Center. He
is also Professor Emeritus of Psychology at the University of
Plymouth and the University of Hull in the UK and University of
Connecticut in the US. He has published 10 books and more than 250
scientific journal articles and book chapters on placebo effects,
antidepressant medication, hypnosis, and suggestion. He originated
the concept of response expectancy. His meta-analyses on the
efficacy of antidepressants were covered extensively in the
international media and influenced official guidelines for the
treatment of depression in the United Kingdom. His 2009 book, The
Emperor’s New Drugs: Exploding the Antidepressant Myth, was
shortlisted for the prestigious Mind Book of the Year award and was
the topic of 60 Minutes segment on CBS and a 5-page cover story in
Newsweek.

In this interview, we discuss Dr
Kirsch’s research into the placebo effect and the efficacy of drugs
used for depression.

In this episode we
discuss:

How, as an undergraduate
student, Dr Kirsch became interested in behavioural therapy but
that he doubted the rationale behind these approaches

That this led to an interest in
beliefs that people had and research into the placebo
effect

How, while working at the
University of Connecticut, his research into the placebo led to an
interest in the efficacy of antidepressant drugs when compared to
placebo

How his work led to the
surprising conclusion that, were antidepressant drugs were
concerned, the placebo effect was so large that there was very
little room for a meaningful drug effect

How this changed Dr Kirsch’s
views on antidepressant drugs entirely, causing him to ask whether
the risks were worth the small benefit for depressed
patients

That a belief that a person has
can affect their response to a drug either in a positive way
(placebo) or in a negative way (nocebo)

Dr Kirsch found that there are
many conditions that can show a profound placebo effect including
depression, anxiety, irritable bowel syndrome, pain, Parkinson’s
disease and asthma

That the placebo tends to have a
greater effect in conditions that have a large psychological
component when compared to functional disorders such as
diabetes

That placebo can have an effect
even if the patient knows that they are taking an inactive tablet
and that part of this response is down to classical
conditioning

That Dr Kirsch is working on
‘open-label placebo’ which is being able to prescribe placebo to
patients without deception

That Dr Kirsch used to refer
depressed patients for antidepressant treatments, but that his
research made him a disbeliever when looking at the evidence of
efficacy when compared to placebo

How, when you give someone a new
treatment, that often will counter feelings of hopelessness that
characterise depressive experiences

That in looking at this size of this effect, it made
clear that the difference between placebo response and
antidepressant response was so small that it was not clinically
significant

That even drugs with very
different modes of action resulted in virtually identical responses
in patients, for example, Tianeptine, which is an SSRE
(selective serotonin reuptake
enhancer) and decreases serotonin levels between neurons, this drug
should make depressed people worse but instead, it showed the same
efficacy as SSRI antidepressants

How, when looking at the
clinical trials used to demonstrate antidepressant efficacy, it
became clear that the obvious nature of antidepressant adverse
effects meant that trial participants would often “break blind” and
they would know if they were in the active drug group or the
placebo group, this would naturally influence the results of the
trial

That, in a small number of
studies, an active placebo was used, which was a substance that
mimicked the side effects of the active drug while having no
clinical effect itself

That in these active placebo
studies, you were much less likely to get a significant difference
between drug and placebo when compared to trials that used an
intern placebo

That the trials conducted by
pharmaceutical manufacturers are designed to show their drug in the
best possible light and so they do not use active placebo in their
studies

That Dr Kirsch feels that when
conducting trials for drugs used for depression, patients should be
asked early on in the trial whether they think they are in the
active group or the placebo group and that this question would help
ensure the trials were reliable

How, when using the data from
unpublished trials, the difference between placebo effect and drug
effect was even smaller

How Dr Kirsch was pleased that
other researchers found his conclusions controversial because it
meant that they were paying attention to the study and that others
who have replicated the approach have found similar
results

That influencing clinicians to
better balance risk vs benefit will take time and that we need to
share the data and discuss the conclusions as much as we can to
allow change to happen

That people do need help with
depression and that there are many different interventions that are
at least as effective as antidepressants but without the associated
risk

How we can’t infer that
‘off-label’ prescribing is effective until the studies have been
undertaken for a particular disorder

About the Podcast

Welcome to the Mad in America podcast, a new weekly discussion that searches for the truth about psychiatric prescription drugs and mental health care worldwide.
This podcast is part of Mad in America’s mission to serve as a catalyst for rethinking psychiatric care and mental health. We believe that the current drug-based paradigm of care has failed our society and that scientific research, as well as the lived experience of those who have been diagnosed with a psychiatric disorder, calls for profound change.
On the podcast over the coming weeks, we will have interviews with experts and those with lived experience of the psychiatric system. Thank you for joining us as we discuss the many issues around rethinking mental health around the world.
For more information visit madinamerica.com
To contact us email podcasts@madinamerica.com